Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer

AIM： To assess the prevalence of clinically significant lesions in patients with minimal bright red bleeding per rectum （BRBPR）. METHODS： Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defined as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded： Positive personal history of colorectal neoplasms or inflammatory bowel disease （IBD）, positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, and presence of iron deficiency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were defined as significant lesions. RESULTS： A total of 402 patients （183 female and 219 male, aged 43.6 ± 15.7 years） were studied. Hemorrhoids （54.2%）, anal fissures （14.2%） and ul- cerative colitis （14.2%） were the most common lesions and colonoscopy was normal in 8.0%. Significant lesions were found in 121 （30.1%） patients, including 26 patients （6.5%） with adenocarcinoma and 30 （7.5%） with adenomatous polyps. Almost all patients with significant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids. CONCLUSION： Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. Thechoice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.     

Efficacy of ankaferd blood stopper application on nonvariceal upper gastrointestinal bleeding

AIM:To prospectively assess the hemostatic efficacy of the endoscopic topical use of ankaferd blood stopper(ABS) in active non-variceal upper gastrointestinal system(GIS) bleeding.METHODS:Endoscopy was performed on 220 patients under suspiciency of GIS bleeding.Patients with active non-variceal upper gastrointestinal bleeding(NVUGIB) with a spurting or oozing type were included.Firstly,8-10 cc of isotonic saline was sprayed to bleeding lesions.Then,8 cc of ABS was applied on lesions in which bleeding continued after isotonic saline application.The other endoscopic therapeutic methods were applied on the lesions in which the bleeding did not stop after ABS.RESULTS:Twenty-seven patients had an active NVUGIB with a spurting or oozing type and 193 patients were excluded from the study since they did not have non-variceal active bleeding.8 cc of ABS was sprayed on to the lesions of 26 patients whose bleeding continued after isotonic saline and in 19 of them,bleeding stopped after ABS.Other endoscopic treatment methods were applied to the remaining patients and the bleeding was stopped with these interventions in 6 of 7 patients.CONCLUSION:ABS is an effective method on NVUGIB,particularly on young patients with no coagulopathy.ABS may be considered as part of a combination treatment with other endoscopic methods.     

Efficacy, risk factors and complications of endoscopic polypectomy： Ten year experience at a single center

AIM： To examine the efficacy and complications of colonoscopic resection of colorectal polypoid lesions. METHODS： We retrospectively reviewed 1354 polypectomies performed on 1038 patients over a ten- year period. One hundred and sixty of these were performed for large polyps, those measuring ≥ 20 mm. Size, shape, location, histology, the technique of polypectomy used, complications, drugs assumption and associated intestinal or extra intestinal diseases were analyzed. For statistical analysis, the Pearson χ2 test, NPC test and a Binary Logistic Regression were used. RESULTS： The mean patient age was 65.9 ± 12.4 years, with 671 men and 367 women. The mean size of polyps removed was 9.45 ± 9.56 mm while the size of large polyps was 31.5 ± 10.8 mm. There were 388 pedunculated and 966 sessile polyps and the most common location was the sigmoid colon （41.3%）. The most frequent histology was tubular adenoma （55.9%） while for the large polyps was villous （92/160 -57.5%）. Coexistent malignancy was observed in 28 polyps （2.1%） and of these, 20 were large polyps. There were 17 procedural bleeding （1.3%） and one perforation. The statistical analysis showed that cancer is correlated to polyp size （P 〈 0.0001）; sessile shape （P 〈 0.0001） and bleeding are correlated to cardiac disease （P = 0.034）, tubular adenoma （P = 0.016） and polyp size.CONCLUSION： The endoscopic resection is a simple and safe procedure for removing colon rectal neoplastic lesions and should be considered the treatment of choice for large colorectal polyps. The polyp size is an important risk factor for malignancy and for bleeding.     

Risk factors for bleeding after endoscopic mucosal resection

AIM: To clarify the risk factors for bleeding after endoscopic mucosal resection (EMR). METHODS: A total of 297 consecutive patients who underwent EMR were enrolled. Some of the patients had multiple lesions. Bleeding requiring endoscopic treatment was defined as bleeding after EMR. Odds ratios (OR) with 95% confidence intervals (CI), calculated by logistic regression with multivariate adjustments for covariates, were the measures of association. RESULTS: Of the 297 patients, 57 (19.2%) patients with bleeding after EMR were confirmed. With multivariate adjustment, the cutting method of EMR, diameter, and endoscopic pattern of the tumor were associated with the risk of bleeding after EMR. The multivariate-adjusted OR for bleeding after EMR using endoscopic aspiration mucosectomy was 3.07 (95%CI, 1.59-5.92) compared with strip biopsy. The multiple-adjusted OR for bleeding after EMR for the highest quartile (16-50 mm) of tumor diameter was 5.63 (95%CI, 1.84-17.23) compared with that for the lowest (4-7 mm). The multiple-adjusted OR for bleeding after EMR for depressed type of tumor was 4.21 (95%CI, 1.75-10.10) compared with elevated type. CONCLUSION: It is important to take tumor characteristics (tumor size and endoscopic pattern) and cutting method of EMR into consideration in predicting bleeding after EMR.     

Feasibility of cold snare polypectomy in Japan: A pilot study

AIM: To investigate the feasibility of cold snare polypectomy(CSP) in Japan.METHODS: The outcomes of 234 non-pedunculated polyps smaller than 10 mm in 61 patients who underwent CSP in a Japanese referral center were retrospectively analyzed. The cold snare polypectomies were performed by nine endoscopists with no prior experience in CSP using an electrosurgical snare without electrocautery.RESULTS: CSPs were completed for 232 of the 234 polyps. Two(0.9%) polyps could not be removed without electrocautery. Immediate postpolypectomy bleeding requiring endoscopic hemostasis occurred in eight lesions(3.4%; 95%CI: 1.1%-5.8%), but all were easily managed. The incidence of immediate bleeding after CSP for small polyps(6-9 mm) was significantly higher than that of diminutive polyps(≤ 5 mm; 15% vs 1%, respectively). Three(5%) patients complained of minor bleeding after the procedure but required no intervention. The incidence of delayed bleeding requiringendoscopic intervention was 0.0%(95%CI: 0.0%-1.7%). In total, 12% of the resected lesions could not be retrieved for pathological examination. Tumor involvement in the lateral margin could not be histologically assessed in 70(40%) lesions.CONCLUSION: CSP is feasible in Japan. However, immediate bleeding, retrieval failure and uncertain assessment of the lateral tumor margin should not be underestimated. Careful endoscopic diagnosis before and evaluation of the tumor residue after CSP are recommended when implementing CSP in Japan.     

Detection and treatment of synchronous lesions in colorectal cancer： The clinical implication of perioperative colonoscopy

AIM： To evaluate the clinical significance of preand intra-operative colonoscopy for the detection of synchronous lesions in colon cancer.
METHODS： Two hundred and sixty-five pre-operative and 51 intra-operative colonoscopic evaluations were performed in 316 colorectal cancer patients who underwent curative resection from January 2001 to June 2006. The incidence and characteristics of synchronous lesions and their influence on surgery were evaluated.
RESULTS： Two hundred and eighty-two synchronous lesions were detected in 124 （39.2%） of 316 patients including all lesions regardless of their histologic type. True adenomatous polyps were found in 91 （28.8%） of 326 patients, and 27 （5.4% of all patients） patients had synchronous colon cancers. The preoperative identification of synchronous lesions altered the planned surgery in 37 （14.0%） of 265 patients. In 18 patients among the surgically removed cases, the lesions were removed by extending the resection range. Further segmental resection or polypectomy through enterotomy was necessary in 29 patients. Nineteen （37.2%） of 52 intraoperative colonoscopy cases had synchronous lesions. Additional surgical procedures including segmental bowel resection and polypectomy with enterotomy were necessary in 7 （23.7%） of 52 intraoperative colonoscopy cases to remove the lesions.
CONCLUSION： Synchronous colorectal polyps or cancer are frequent and their preoperative detection is important for optimal surgical planning and treatment. Intraoperative colonoscopy is a useful option in cases where a preoperative colonoscopy is not feasible.     

Clinical features of upper gastrointestinal serrated lesions: An endoscopy database analysis of 98746 patients

AIM To analyse the clinical features of patients with the serrated lesions in the upper gastrointestinal tract(UPGI) tract.METHODS Patients who underwent routine esophagogastroduodenoscopy(EGD) at the Digestive Endoscopy Centre of General Hospital, Tianjin Medical University between january 2011 and December 2015 were consecutively recruited. Patients with UPGI serrated lesions were consecutively identified. The patients' demographics and histopathology were recorded. The colorectal findings for patients who underwent colonoscopy simultaneously or within six months were also extracted from the colonoscopy database. In addition, we analyseddifferences in colorectal neoplasia detection between the study patients and randomly selected patients matched for age and gender who did not exhibit serrated lesions and who also underwent colonoscopy in the same period.RESULTS A total of 21 patients out of 98746 patients(0.02%) who underwent EGD were confirmed to have serrated lesions with predominantly crenated, sawtooth-like configurations. The mean age of the 21 patients was(55.3 ± 17.2) years, and 11 patients were male(52.4%). In terms of the locations of the serrated lesions, 17 were found in the stomach(including 3 in the cardia, 9 in the corpus and 5 in the antrum), 3 were found in the duodenum, and 1 was found in the esophagus. Serrated lesions were found in different mucosal lesions, with 14 lesions were detected in polyps(8 hyperplastic polyps and 6 serrated adenomas with low grade dysplasia), 3 detected in Ménétrier gastropathy, 3 detected in an area of inflammation or ulcer, and 1 detected in the intramucosal carcinoma of the duodenum. In addition, colonoscopy data were available for 18 patients, and a significantly higher colorectal adenoma detection rate was observed in the UPGI serrated lesions group than in the randomly selected age- and gender-matched group without serrated lesions who also underwent colonoscopy in the same period(38.9% vs 11.1%, OR = 5.091, 95%CI: 1.534-16.890, P = 0.010). The detection rate of advanced adenoma was also higher in the UPGI serrated lesions group(22.2% vs 4.2%, OR = 6.571, 95%CI: 1.322-32.660, P = 0.028).CONCLUSION Serrated lesions in the UPGI were detected in various mucosal lesions with different pathological morphologies. Moreover colonoscopy is recommended for the detection of concurrent colorectal adenoma for these patients.     

What can be the criteria of outpatient-based endoscopic resection for colon polyp?

AIM: To investigate whether out-patient based endo-scopic mucosal resection(EMR) for colon polyps ≤ 10 mm is safe.METHODS: Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients were retrospectively reviewed. The factors contributing delayed hemorrhage were analyzed. We calculated the probability of delayed bleeding after stratifying conditions of specific risk factors.RESULTS: The size of the polyp(95%CI: 1.096-1.164, P 0.001) and patients with chronic renal failure(95%CI: 1.856-45.106, P = 0.007) were identified as independent risk factors for delayed bleeding in multi-variate analysis. 95%CI for percent of delayed bleedingaccording to polyp size was determined for the fol-lowing conditions: size ≤ 10 mm, 0.05%-0.43%; 20 mm ≥ size 10 mm, 0.54%-2.08%; size 20 mm, 4.22%-11.41%. 95%CI was determined for the risk of serious immediate bleeding for a polyp ≤ 10 mm was 0.10%-0.56%. Finally, 95%CI for percent of incomplete resection was 0.07%-0.49% in polyps ≤ 10 mm. CONCLUSION: It seems acceptable to perform outpa-tient-based EMR for colon polyps ≤ 10 mm.     

Evaluation of non-ampullary duodenal polyps: Comparison of non-neoplastic and neoplastic lesions

AIM: To evaluate duodenal polyps, divided into nonneoplastic and neoplastic lesions. In addition, the clinical characteristics of duodenal hyperplastic polyps are determined. METHODS: We analyzed medical records of 50 114 consecutive patients submitted to for first diagnostic esophago-gastroduodenoscopy between January 2004 and December 2009. We excluded lesions on the ampulla of Vater and submucosal tumors. We studied 510 cases that were diagnosed endoscopically with duodenal polyps and enrolled a total of 221 cases that had undergone tissue biopsy. We analyzed the differences between non-neoplastic and neoplastic lesions, and determined the clinical features of duodenal hyperplastic polyps. RESULTS: Non-neoplastic lesions were found in 196 patients and neoplastic lesions in 25 patients. On uni-variate analysis, there were significant differences in shape, location, and size. Polyps more than 10 mm in diameter or polyps in the second portion had independent risk factors for being neoplastic lesions, as identified by multivariate analysis. In 23 cases of hyperplastic polyps (79.3%), they were accompanied by gastroduodenal pathology, which was possibly associated with Helicobacter pylori . CONCLUSION: Polyps of more than 10 mm or polyps in the second portion of the duodenum should be evaluated by histological examination.     

Non-steroidal anti-inflammatory drug-induced small bowel injuries identified by double-balloon endoscopy

AIM: To clarify clinical features of the NSAID-induced small bowel lesions using a new method of endoscopy. METHODS: This is a retrospective study and we analyzed seven patients with small bowel lesions while taking NSAIDs among 61 patients who had undergone double-balloon endoscopy because of gastro-intestinal bleeding or anemia between September 2000 and March 2004, at Jichi Medical School Hospital in Japan. Neither conventional EGD nor colonoscopy revealed any lesions of potential bleeding sources including ulcerations. Double-balloon endoscopy was carried out from oral approach in three patients, from anal approach in three patients, and from both approaches in one patient. RESULTS: Ulcers or erosions were observed in the ileum in six patients and in the jejunum in one patient, respectively. The ulcers were multiple in all the patients with different features from tiny punched out ulcers to deep ulcerations with oozing hemorrhage or scar. All the patients recovered uneventfully and had full resolution of symptoms after suspension of the drug. CONCLUSION: NSAIDs can induce injuries in the small bowel even in patients without any lesions in both the stomach and colon.     

色素内镜联合内镜黏膜切除术诊治结直肠侧向发育型肿瘤的临床研究

背景:结直肠侧向发育型肿瘤(LST)与结直肠癌关系密切。目的:探讨色素内镜联合内镜黏膜切除术(EMR)对结直肠LST的临床诊疗价值。方法:纳入2009年7月～2012年2月于达县人民医院行结肠镜检查发现可疑病灶的患者2200例,对病灶内镜下喷洒0.4%靛胭脂行黏膜染色。对染色发现的LST,观察病灶大小并进行形态分型。对LST病灶行EMR或内镜分片黏膜切除术(EPMR),未能行EMR或EPMR者行内镜下活检。结果:黏膜染色后发现结直肠LST患者28例,共30个LST病灶。30个LST病灶中颗粒均一型14个(46.7%),结节混合型8个(26.7%),平坦隆起型5个(16.7%),假凹陷型3个(10.0%);行EMR19个(63.3%),行EPMR6个(20.0%),行内镜下活检5个(16.7%)。病理学检查示早期结直肠癌4个(13.3%),进展期结直肠癌3个(10.0%),腺瘤23个(76.7%)。结论:色素内镜可有效发现结直肠LST病灶。色素内镜联合EMR或EPMR根除LST病灶对早期结直肠癌的防治具有积极意义。     

结直肠肿瘤样病变内镜活检与黏膜切除术后病理诊断比较

背景：结直肠肿瘤样病变内镜黏膜切除术（EMR）后病理诊断与术前内镜活检病理诊断的差异未明。目的：评估放大色素内镜指导下EMR获得的结直肠肿瘤样病变标本的诊断价值。方法：连续收集接受EMR治疗的直径≤2cm的无蒂型或平坦、凹陷型结直肠肿瘤样病变纳入研究,分析EMR病理诊断与术前活检病理诊断的差异。结果：共纳入EMR切除病灶90个,无蒂型25个,平坦、凹陷型65个,后者为高度异型增生（HGD）或腺癌的可能性略高于前者（41．5％对20．0％,P〉0．05）。术前活检病理诊断的总体准确性为68．9％,28个（31．1％）病灶的诊断于术后发生改变．其中4个增生性病变术后均诊断为低度异型增生（LGD）,14个LGD诊断为HGD,5个LGD诊断为腺癌,5个HGD诊断为腺癌。病灶形态学表现及其浸润深度与病理诊断结果的改变无关。结论：放大色素内镜指导下的EMR病理诊断纠正了本组近1／3结直肠肿瘤样病变的术前活检病理诊断,具有完善诊断和治疗的双重作用。     

内镜黏膜切除术治疗大肠广基大息肉

目的探讨内镜黏膜切除术(EMR)对肠道广基大息肉样病变的治疗价值。方法采用结肠镜下大肠黏膜切除术治疗135例共157个结直肠广基大息肉。病灶黏膜下注射肾上腺素生理盐水后,一次圈套整块切除或分次圈套切除病变,回收全部标本送病理检查,术后结肠镜随访。结果全部息肉EMR一次切除,除3个位于直肠黏膜下的病灶小于1 cm外,其余均大于1.5 cm,最大的13 cm×12 cm,无手术并发症。术后病理:腺瘤123个,其中有异型增生80个;黏膜内癌11个;增生性息肉20个;直肠类癌3个。随访中,有2例大于7 cm的直肠腺瘤分别于术后1个月及3个月复查时复发,均给予热活检钳完整钳除,病理分别为增生性息肉和绒毛状腺瘤,再复查6-12个月无复发。结论EMR是治疗大肠癌前病变及黏膜内癌安全、有效的方法。     

内镜下切除非壶腹部十二指肠腺瘤的临床价值

目的探讨内镜下切除非壶腹部十二指肠腺瘤的安全性及有效性。方法对非壶腹部十二指肠腺瘤（均≥1cm）患者,采用内镜下黏膜切除术,对抬举征阳性者进行一次圈套整块切除或分次圈套切除;回收组织送病理检查。术后进行内镜随访。结果20例中6例（30％）腺瘤位于十二指肠球部,13例（65％）位于十二指肠降部,1例（5％）位于十二指肠水平部。病灶直径平均（1．9±1．1）em,其中1．0～2．0em14例,〉2．0em6例。12例（60％）切除前行超声内镜检查,腺瘤均起源于黏膜层。15例整块切除,5例分块切除,平均操作时间（33．8±16．7）min。术后出血4例,均发生于术后24h内,内镜下止血均成功;无穿孔发生。术后病理检查,均获完整切除,管状腺瘤14例（70％）,绒毛管状腺瘤6例（30％）。17例术后随访2—39个月,1例于术后6个月复发,余16例无复发。结论内镜下切除非壶腹部十二指肠腺瘤是安全、有效的。     

EMR of large sessile colorectal polyps

BACKGROUND: EMR optimizes histopathologic assessment of resected lesions. This study evaluated the outcome of EMR of large sessile colorectal polyps in terms of complications and recurrence. METHODS: An uncontrolled prospective study was conducted of a cohort of 136 patients with sessile colorectal polyps referred for EMR. After submucosal injection, EMR was performed piecemeal by either snare polypectomy alone or with cap aspiration. RESULTS: In 136 patients, a total of 139 sessile polyps were resected, 86 of which were in the right colon. Median polyps diameter was 20 mm in the right colon and 30 mm in the other colonic segments. Intraprocedure bleeding occurred after 15 polypectomies (10.8%) and was controlled endoscopically in all cases; there was no delayed bleeding. Post-polypectomy syndrome occurred in 5 patients (3.7%). There was no perforation. Invasive carcinoma was found in 17 sessile colorectal polyps, and surgery was performed in 10 of 17 cases. Follow-up colonoscopy in 93 patients without invasive carcinoma (96 polyps), over a median of 12.3 months, disclosed local recurrence of 21 adenomatous polyps (21.9%). Colonoscopic follow-up in 5 of the 7 patients, who had sessile colorectal polyps with invasive carcinoma and did not undergo surgery, disclosed no local recurrence. CONCLUSIONS: EMR, including EMR with cap aspiration, is effective and safe for removal of sessile colorectal polyps throughout the colon.     

内镜下黏膜切除术治疗老年及老年前期胃肠道息肉的临床研究

目的探讨内镜下黏膜切除术（endoscopic mucosal resection,EMR）对老年及老年前期胃及大肠息肉的治疗效果,并对其临床病理特征、适应证、并发症等进行讨论。方法 2003年10月至2009年10月共完成老年及非老年胃息肉及大肠息肉EMR手术1076例;对切除标本进行病理检查,记录术中及术后发生的并发症及处理情况,术后定期内镜随访1-60月。结果 348处胃息肉经首次或再次EMR治疗病变均完整清除,病理示炎性息肉、增生性息肉、腺瘤性息肉分别占62.6%（218/348）,27.9%（97/348）,9.5%（33/348）。935处大肠息肉中892处病变经首次或再次EMR治疗病变完整清除,治愈率为95.4%;23处病变（2.5%）术后病理示浸润癌再追加外科开腹手术。病理示炎性息肉、增生性息肉、腺瘤性息肉、腺瘤癌变分别占29.1%（272/935）,20.9%（195/935）,46.2%（432/935）,3.9%（36/935）,随年龄的增加,腺瘤性息肉的比例逐渐升高（P〈0.01）。术中出血52例（4.8%）,均内镜下止血;术后迟发出血（〉24 h）21例（2.0%）,其中15例经内镜下止血,6例经输血及内科保守治疗后止血。无穿孔、感染等并发症发生。随访期间所有病例均无复发。结论 EMR是一种安全和微创的内镜治疗手段,对老年及老年前期胃及大肠息肉治疗的疗效优于传统的内镜下治疗方法。     

内镜下黏膜切除术治疗胃肠道息肉样病变的70例临床分析

目的 探讨内镜下黏膜切除术（ endoscopic mucosal resection,EMR） 在切除胃肠道息肉中的应用价值.方法 回顾性分析70例（82枚息肉）行EMR治疗胃肠道息肉的临床资料.结果 30例患者40枚胃息肉及40例患者42枚结肠息肉经EMR 治疗后,病变均完整切除,无出血、感染和穿孔等并发症发生.结论 EMR是临床上治疗胃肠道息肉的一种安全有效的内镜治疗手段,值得临床推广.     

大肠侧向发育型肿瘤内镜下的诊断与治疗

目的探讨大肠侧向发育型肿瘤（LST）临床病理特征及内镜下黏膜切除术的有效性、安全性。方法经普通内镜检查发现LST 119例,染色后观察病灶大小及部位并进行形态分型,再结合放大内镜确定腺管开口类型。有治疗适应证者行内镜下黏膜切除术,切除病灶黏膜送病理检查。结果 28个月中共发现119例LST 124个病变。内镜下分型：颗粒均一型44个,结节混合型48个,平坦隆起型23个,假凹陷型9个。病变直径：10～20 mm 65个,21～30 mm 23个,31 mm以上36个,最大病变110 mm×100 mm。病变部位：直肠50个,乙状结肠25个,降结肠11个,横结肠10个,升结肠＋盲肠28个。黏膜腺管开口类型：Ⅲ型30个,其中17个为管状绒毛状腺瘤,12个为管状腺瘤;Ⅳ型56个,其中30个为绒毛状腺瘤,4个为黏膜内癌;Ⅴ型5个,其中2个为黏膜内癌,2个累及黏膜下层下1/3以下;Ⅱ型7个,其中5个为炎性增生性息肉,2个为锯齿状腺瘤（腺瘤性增生性息肉）：其余为ⅢL＋V型,其中23个为管状绒毛状腺瘤。符合适应证95例98个病变择期进行内镜下黏膜切除治疗,发生出血11例,均在操作过程中,无肠穿孔发生。结论大肠LST内镜形态具有一定特殊性,内镜下黏膜切除术是治疗在大肠的有效而安全的方法,可达到根治目的 。     

黏膜切除术治疗结直肠广基隆起性腺瘤性息肉98例临床研究

目的探讨内镜下黏膜切除术(endoscopic mucosal resection,EMR)治疗结直肠广基隆起性腺瘤性息肉患者的疗效。方法回顾性分析98例结直肠广基隆起性腺瘤性息肉(息肉直径0.6~2.0 cm)患者的临床资料并行EMR治疗。结果 98例均经电子结肠镜检查及术前病理诊断为腺瘤性息肉,均为广基隆起性病变,共120枚,行EMR,留取完整标本病理检查,创面均给予钛夹封闭。术后病理诊断为腺瘤性息肉113例,高级别瘤变4例,局部癌变3例,7例切缘均无癌细胞,未追加外科手术。1个月后复查见病变部位黏膜光滑,未见息肉及病变黏膜残留。高级别瘤变及局部癌变7例随访3年,未见肿瘤复发及它处转移。结论对于广基隆起性腺瘤性息肉行EMR较既往单纯的高频电灼或氩离子凝固术有助于发现早期癌,改善患者的预后。     

麻醉肠镜在老年患者大肠息肉黏膜切除术中的应用

目的探讨麻醉肠镜在老年患者大肠息肉行黏膜切除术(endoscopic mucosal resection,EMR)中的临床应用价值。方法将306例肠镜下发现大肠息肉的老年患者随机分为两组:麻醉肠镜组(156例);使用异丙酚和芬太尼行静脉麻醉;普通肠镜组(150例):仅给予肠道准备。观察两组患者EMR术前、中、后的血压[包括舒张压(SBP)、收缩压(DBP)]、心率(HR)、末梢血氧饱和度(Sp O2)和两组患者术中反应、并发症、手术操作时间及患者满意度。结果术中麻醉肠镜组SBP、DBP、HR均明显低于普通肠镜组(P均0.05),Sp O2无显著差异(P0.05);术前及术后两组患者SBP、DBP、HR、Sp O2均无显著性差异(P均0.05)。麻醉肠镜组患者满意度高。麻醉组手术操作时间(18.1±6.3)min,普通组(24.4±8.5)min,两组比较,差异有统计学意义(P0.05)。结论麻醉肠镜下对老年患者大肠息肉行EMR能够缩短操作时间,提高成功率,提高患者满意度,是一种治疗老年患者大肠息肉的简单、安全、有效的方法。